ArticleHealth services research2021
High-deductible health plans and low-value imaging in the emergency department.
Article in Health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Interventions to improve the quality of low back pain care in emergency departments: a systematic review and meta-analysis.Internal and emergency medicine · 2024Pooled it
- A hurdle and negative binomial model approach to analyzing the gender differences in diagnostic imaging utilization under high-deductible health plans.Frontiers in public health · 2025Article
- Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2022Article
- Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care.Circulation · 2021Article
- High-Deductible Health Plans and Emergency Care for Chest Pain: To Go or Not to Go.Circulation · 2021Article
- High-deductible health plans and low-value imaging in the emergency department.Health services research · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectiveTo examine the effect of an employer-mandated switch to high-deductible health plans (HDHP) on emergency department (ED) low-value imaging. DATA SOURCES: Claims data of a large national insurer between 2003 and 2014. STUDY
designDifference-in-differences analysis with matched control groups. DATA COLLECTION/EXTRACTION
methodsThe primary outcome is low-value imaging during ED visits for syncope, headache, or low back pain. We included members aged 19-63 years whose employers offered only low-deductible (≤$500) plans for one (baseline) year and, in the next (follow-up) year, offered only HDHPs (≥$1000). Contemporaneous members whose employers offered only low-deductible plans for two consecutive years served as controls. The groups were matched by person and employer propensity for HDHP switch, employer size, baseline calendar year, and baseline year quarterly number of total and imaged ED visits for each condition. We modeled the visit-level probability of low-value imaging using multivariable logistic regression with member-clustered standard errors. We also calculated population level monthly cumulative ED visit rates and modeled their trends using generalized linear regression adjusting for serial autocorrelation. PRINCIPAL
findingsAfter matching, we included 524 998 members in the HDHP group and 5 448 803 in the control group with a mean age of approximately 42 years and 48% female in both groups. On visit-level analyses, there were no significant differential changes in the probability of low-value imaging use in the HDHP and control groups. In population-level analyses, compared with control group members, members who switched to HDHPs experienced a relative decrease of 5.9% (95% CI - 10.3, -1.6) in ED visits for the study conditions and a relative decrease of 5.1% (95%CI -9.6, -0.6) in the subset of ED visits with low-value imaging.
conclusionThough HDHP switches decreased ED utilization, they had no significant effect on low-value imaging use after patients have decided to seek ED care.
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